What is the 33rd Amendment to Regulation 83 and how does it affect no-fault claims?
The 33rd amendment primarily affects situations where a patient residing in New York receives treatment from an out-of-state medical provider. Prior to the 33rd amendment to Regulation 83, the maximum permissible charge for treatment received outside of New York State was the prevailing fee in the geographic location of the health provider.
The 33rd amendment limits reimbursement to the lowest of:
- The amount of the fee in the region in New York State that has the highest applicable amount in the fee schedule for that service;
- The amount charged by the provider; and
- The prevailing fee in the geographic location of the provider.
This limitation on reimbursement does NOT apply to:
- Services provided out-of-state that would constitute emergency care;
- That is provided to a non-resident of New York State: or
- A New York State resident who, at the time of treatment, is residing in the jurisdiction where the treatment is being rendered for reasons unrelated to the treatment.
Under these three exceptions, reimbursement is at the lower of the amount charged by the provider and the prevailing fee in the geographic location of the provider. If the jurisdiction where the out-of-state provider renders treatment has established a fee schedule for services rendered in connection with motor vehicle-related injuries, the prevailing fee shall be the amount prescribed in that fee schedule for the respective service.